New York authorities last year slapped a crooked quack on the wrist rather than seek jail time — a deadly deal that might have cost four women their lives.

Hector Cabral, accused of the unauthorized practice of medicine, could have been thrown behind bars for 20 years, but instead paid a fine and returned home to the Dominican Republic, where he continued to pursue his bloody brand of plastic surgery.

Licensed in his native country but not here, he continued to lure American women to his operating table for cut-rate cosmetic procedures.

Erika Hernandez, 31, traveled from Washington Heights to Cabral’s Santo Domingo offices last month for an operation that would have cost more than $15,000 in New York. But Cabral would do the tummy tuck, liposuction, lipo sculpture and butt implants for about $6,000.

The seven-hour surgery was not even over when the anesthesia began to wear off, and Hernandez awoke screaming, “Damn, it hurts!”

An operating-room aide snapped, “Damn, shut up!”

Hernandez related the nightmare to her friend Jennifer Torres, who accompanied her friend, the mother of seven children ranging in age from 7 months to 15 years.

“Erika came out crying. She said her right leg hurt,” Torres told The Post.

After 17 days of excruciating pain and high fevers, Hernandez died Aug. 29 at another clinic in Santiago.

“It’s pure malpractice,” said Hernandez’s mother, Adela Ventura, who blames not only Cabral but the New York authorities who let the butcher off easy.

Cabral, 52, was busted in 2011, accused of trolling for patients at hair and nail salons in Washington Heights, where he would examine women — sometimes drawing on their bodies with markers — and entice them to visit his sleek-looking International Center for Advanced Plastic Surgery in the Dominican Republic.

Attorney General Eric Schneiderman charged Cabral with 10 counts of unauthorized practice of medicine for the beauty-salon exams.

But Schneiderman’s office struck a deal before trial. Cabral pleaded guilty to just one charge, got no jail time, and was instead fined $5,000, ordered to pay $23,055 in restitution and do 250 hours of community service — back in the Dominican Republic.

At his sentencing last year, former patient Lissette Mejia of The Bronx said she woke up from her procedure with burned skin across her stomach.

“He just simply sent me here to New York to die,” she told the judge.

Cabral’s clinic was closed for 10 days this June by Dominican authorities after three women — all from overseas — died. Cabral, the clinic owner, was reportedly not the surgeon on those cases.

Hernandez and her family had no idea of Cabral’s bloody trail.

“They shouldn’t have let him go to kill my daughter,” said Ventura.

A Schneiderman spokeswoman said “when it became clear the court was not going to put this doctor behind bars, we insisted on the largest possible restitution allowable by law.”

But a court spokesman countered: “This was a plea offer made by the Attorney General’s Office. The option to take the case to trial was one they chose not to exercise.”

Cabral’s brother, Hector, said “all proper procedures were followed” and that Hernandez herself “abandoned her treatment.”

Hernandez was part of a “lipotourism” pipeline from New York City to the Dominican Republic. By one estimate, 80 percent of plastic-surgery patients in the DR live outside of the country.

In 2003, women began returning from the Caribbean nation with serious and disfiguring bacterial infections that required months of antibiotic treatment. With nine New York City women infected, the city issued warnings in 2004 against traveling to the DR for surgery.

“Ultimately, what’s more expensive — saving some money there or losing your life,” said New York City plastic surgeon Steve Fallek who treated a woman with the bacterial infection and others disfigured by cut-rate surgery.